Entrepreneur of the Year Nomination Form Field

Entrepreneur of the Year Nomination Form – Field

CR-005 Last Update: 01 March 2017 Type of Nomination: P&D Linehaul Results and information from June 1-Feb 28/29 (of the current fiscal year) should be used to complete this form.

Station/Hub Station/Hub Name: Number:

Dis District: Region:

Nominee:

Nominator (if different):

Business name/CSP Profile Number: CSPO Business address:

Tax ID #:

Business phone: Authorized officer: Phone number: Business contact: Phone number: E-mail:

Business Profile Number of years in business: (years contracting with FedEx Ground)

Number of employees:

Business Interests (other than those associated with FedEx Ground):

Last Update: 01 March 2017 Page 1 of 8 Entrepreneur of the Year Nomination Form – Field CR-005 Safety Technologies

FedEx Ground Contract Information

A B C Previous 3 Quarters’ Avg Agreement Type Contract ID# Effective Date Stops / Miles per Day IC FedEx Ground P&D Stops IC FedEx Home Delivery Stops IC FedEx Ground Linehaul Miles ISP FedEx Ground Stops ISP FedEx Home Delivery Stops ISP FedEx Ground and Home Delivery Stops Canada FedEx Ground P&D Stops Canada FedEx Ground Linehaul Miles/km A. This information can be found in CDAS or the Operating Agreement. B. This information can be found in CDAS or the Operating Agreement. C. This information can be found in Settlement statements, P&D Activity, or Business Results.

Comments: Efforts taken by the business to achieve the above results can be listed here:

Service

D E Local Inbound Service Contractor-Related Agreement Type Year-to-Date (YTD) Service Failures (YTD) IC FedEx Ground P&D N/A IC FedEx Home Delivery N/A IC FedEx Ground Linehaul N/A ISP FedEx Ground N/A ISP FedEx Home Delivery N/A ISP FedEx Ground and Home Delivery N/A Canada FedEx Ground P&D N/A Canada FedEx Ground Linehaul N/A D. This information can be found in Business Objects > Public Folder > Package Folder > CSA-PSA IB Local. E. The service information is provided from LH PGH to the field each month.

Safety Record/Vehicle Breakdown Report

F G H I Number of Number of Hours of Agreement Type Fleet accidents disqualified Service (#Units) (preventable) drivers (if any) Violations IC FedEx Ground P&D IC FedEx Home Delivery IC FedEx Ground Linehaul ISP FedEx Ground ISP FedEx Home Delivery ISP FedEx Ground and Home Delivery Canada FedEx Ground P&D Canada FedEx Ground Linehaul F. This information can be found in VMS, Addendum 1 of the operating agreement, or Schedule B of the ISP agreement. G. This information can be found in Business Objects: Public Folders > Safety Department Folder > DOT/Accidents > Accidents by CONTRACTOR FedEx ID# and Safety Results Summary (SRS). H. Contact your Contractor Relations representative or look in Safety Results Summary (SRS). I. Station/Hub can run both P&D and LH Hours of Service Violation reports to determine the number of violations a CSP’s driver had (P&D can only get last 6 months).

Safety Technologies If the business has adopted safety technologies, indicate the number of vehicles next to the type of technology installed.

J P&D - Type of Technology Number of vehicles Telematrics Backing Sonar VEDR

J Linehaul - Type of Technology Number of vehicles Speed Limiter VEDR LDW FCW Telematics FCAM with auto brake

Business Growth and Development Items K and L apply only to P&D independent contractors/independent service providers. K L Delivered Packages-Net Fleet size-Net Variance Operation Type Variance Year-over-Year (YOY) (YOY) IC FedEx Ground P&D IC FedEx Home Delivery ISP FedEx Ground ISP FedEx Home Delivery ISP FedEx Ground and Home Delivery Canada FedEx Ground P&D K. Found in Business Objects > Public Folder > Package Folder > CSA-PSA IB Local. L. Found in VMS, Addendum 1 of the operating agreement, or Schedule B of the ISP agreement.

Items M and N apply only to Linehaul independent contractors. M N Miles/Kilometers Driven- Fleet Size-Net Variance Operation Type Net Variance (YOY) (YOY) IC FedEx Ground Linehaul Canada FedEx Ground Linehaul M. Found in Business Objects >TMS/Contractor & Driver. N. Found in VMS, Addendum 1 of the operating agreement, or Schedule B of the ISP agreement.

Customer Satisfaction (P&D Only)

O Number of verified Operation Type Complaints (YTD) IC FedEx Ground P&D IC FedEx Home Delivery ISP FedEx Ground ISP FedEx Home Delivery ISP FedEx Ground and Home Delivery Canada FedEx Ground P&D O. Found in Business Objects >Complaint Folder > Contractor Relations.

Industry Programs/Community Service Industry-related activities or programs in which the business or its personnel participates (Trucker Buddy, America’s Road Team, state truck driving championships, etc.), as well as community service activities performed and/or its affiliations with civic groups can be listed here:

Industry-related or FedEx Ground recognition that the business or its personnel has received (truck driving championships, safe driving awards, Goodyear Highway Hero, etc.) can be listed here:

Actions the business or its personnel have taken to improve sustainability by reducing its impact on the environment, such as improved fuel efficiency, alternative fuel vehicles, recycling program, etc; other actions taken to work with its community and/or suppliers to understand the environmental impacts of the materials the business uses and improvements that have been made can be listed here:

Business Ethics Actions the business has taken to foster a business culture that ensures all personnel are expected to uphold the highest standards of business ethics and ensure compliance with all applicable laws can be listed here:

Business Nominee’s Statement Why should the business be considered?

Note to FedEx Ground Employees: Refer to Entrepreneur of the Year – CSPs, CRL-204, for form submission information.

P&D Nomination Signatures Required

SRM Acknowledgement:

DMD Review:

RVP Review:

Committee Review:

Linehaul Nomination Signatures Required

SRM / LHSRM Acknowledgement:

*SRM Region LH Operations:

MD Linehaul Operations:

Committee Review:

*For Canada, route to be signed by DMD.

Last Update: 01 March 2017 Page 7 of 8 FedEx Ground Entrepreneur of the Year Nominee

Informed Consent and Release

The undersigned hereby grants to FedEx Ground and its parent and affiliate companies (“FedEx”) the right to use any Likeness (including, but not limited to, recording, film, photographs, audio, image, voice, commentary, dialog, and personal information) for any external media purposes (including, but not limited to, print, video, and social).

The undersigned further agrees and gives permission to FedEx to display, publish, distribute or exhibit such likeness in connection with any promotional materials or otherwise in all manner and media available now or in the future (“Works”), as FedEx determines in its sole discretion without limitation, reservation, or compensation to the undersigned.

The undersigned relinquishes, assigns, conveys, and gives to FedEx all right, title, and interest – including copyright – in and to the Likeness and Works and further grants to FedEx the right to give, sell, or transfer the originals, negatives, reproductions, copies, and facsimiles thereof to any individual, business, firm, entity, or publication or to any of their assignees and to circulate and distribute the same for any and all purposes as described in this Release.

The undersigned hereby waives the right to inspect, approve, or edit any use of the Likeness or any descriptive material used in connection therewith as described in this Release. FedEx may make any and all changes, modifications, rearrangements, additions, or deletions in the Likeness without the undersigned’s prior approval.

The undersigned hereby releases, discharges and agrees to hold harmless FedEx, its agents, representatives, assigns, officers, directors, employees and any other persons, entities and corporations acting under permission or authority of FedEx, including any firm displaying, exhibiting, publishing and/or distributing the finished text, broadcast, recording or reproduction of the Likeness and/or Works, in whole or in part, from and against any liability as a result of any use, distortion, blurring or alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in such activities or in the taking, processing, reproduction or use of the Likeness and/or Works, and the publication, broadcast, use or distribution of the same as described in this Release, even should same subject the Undersigned to ridicule, scandal, scorn or indignity.

This Informed Consent and Release is made on behalf of the undersigned and his or her heirs, executors, successors, administrators and assigns, and it is to be governed by the laws of the Commonwealth of Pennsylvania.

The undersigned hereby represents and certifies he or she has read the foregoing and fully understands the meaning and effect thereof, is above the age of 21 and intending to be legally bound, executes this release for the purposes stated here this ______day of ______, 20______.

Name (print): ______

Signature: ______

Last Update: 01 March 2017 Page 8 of 8